Understanding the nutritional needs of patients
DVM: When considering nutrition for pets, what are the keys to postsurgical recovery?
Remillard: The general rule we use is that animals have to be provided nutritional support within three days. Veterinarians know this general principle, but that does not mean they always follow through on it. Depending on the medical issue, veterinarians may have to wait more than three days to begin feeding, such as with animals hit by a car or animals with chronic vomiting.
DVM: Sick animal care has to present challenges for the general practitioner. Could you offer some advice? How do you get a sick animal to eat if it is refusing?Remillard: I would recommend striving to meet the pet's caloric requirements using tube or parenteral feeding methods if the animal refuses to eat on its own. The animal needs energy and protein to heal.
DVM: Could you describe some of the more unusual cases you treat?
Remillard: There are certainly difficult cases, as well as ones that require some imagination. Additionally, there are many diseases. Basically, if, for some reason, you cannot get an animal to eat or you cannot get to the small bowel, you need to start thinking about providing the animal energy (calories). For example, in the case of a dog hit by a car, the animal may have a lung contusion and difficulty breathing, and it is probably an anesthetic risk. You will need to wait for the lungs to heal. In these cases, the animals usually do not eat. You may want to consider using a parenteral IV.
DVM: What are common problems you see with regard to nutritional management?
Remillard: In cases of pets that are vomiting or that have diarrhea or pancreatitis, veterinarians generally wait too long to feed their patients. They may wait until the animal stops vomiting, which can take five to 10 days in some cases. Often you can lose optimal recovery time by waiting.
DVM: What about current trends in nutrition?
Remillard: In the nutrition field, we are working to address obesity — with some success. There is a general move toward more preventive medicine, weight control, as well as development of foods that are specifically designed to be anti-inflammatory, which can reduce pain medication dosages.
On the horizon, now that the genome has been deciphered in dogs and cats, we are learning that nutrients directly affect the genome. This has the potential to open up a new world where foods with specific nutrients, such as omega-3 fatty acids, can target (+/-) gene expression.
Look for manufacturers to be incorporating those nutrients into the foods they design, based on how they want to influence genetics.
DVM: What is causing the obesity epidemic, and how serious is it?
Remillard: The epidemic is multifactorial, but the bottom line is more pets are obese today. People are overfeeding and under-exercising their pets. Also, consider that the average practice visit with the veterinarian is 20 to 30 minutes, once or twice a year. That is not a lot of time to cover all the necessary information with the client. Sometimes weight control does not get on the agenda. But veterinarians have to get comfortable talking about it. It is an epidemic among kids, adults and pets.
For the veterinarians' part, they need to have more confidence that obesity is actually a disease. Many do not regard it as a disease. If I told 100 practitioners that we have the cure for a disease that affects 30 percent of their patients, they would be excited to hear about this cure. Every third patient is overweight or obese. Obesity is damaging in many ways and costs money to manage. The cure is cost-effective. Obesity contributes to orthopedic diseases, as in the case of a client paying several thousands of dollars to fix a knee, which may have been avoided through weight loss.